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1 March 20, 2019 The Honorable Roy Blunt Chairman Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies Washington, DC The Honorable Rosa DeLauro Chairman House Appropriations Subcommittee on Labor, Health and Human Services, on Labor, Education and Related Agencies Washington, DC The Honorable Patty Murray Ranking Member Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies Washington, DC The Honorable Tom Cole Ranking Member House Appropriations Subcommittee on Labor, Health and Human Services, on Labor, Education and Related Agencies Washington, DC Dear Chairmen Blunt and DeLauro and Ranking Members Murray and Cole, As organizations dedicated to improving the health of all Americans, we respectfully request that you allocate $125 million for FY2020 to the Centers for Disease Control and Prevention s (CDC) Division on Nutrition, Physical Activity and Obesity, which includes $15 million in continued support for the High Obesity Program initiative. CDC s Division of Nutrition, Physical Activity, and Obesity (DNPAO) invests in effective strategies that support healthy eating and active living in states and communities across the nation. Implementing these programs can help prevent obesity and reduce the risk of chronic diseases, such as heart disease, diabetes, stroke, and cancer. Other potential benefits include better school performance, lower health care costs, stronger local economies, less air pollution, more cohesive communities, enhanced national security, and decreasing healthcare costs. For example, if everyone met current physical activity guidelines, Medicare could save $73.9 billion per year. i Currently, DNPAO funds a limited number of states and communities to support these effective evidencebased strategies. An increase in FY 2020 funding for DNPAO will allow CDC to fund all 50 states and D.C. and implement programs that could substantially reduce health care costs [1]. While investments would support state-level entities, funding would be disseminated to individual communities to create more places for physical activity and increase access to healthy foods. These resources would also support the scale of evidence-based health interventions to prevent or control obesity, such as those tested in the Childhood Obesity Research Demonstration project. Active People Healthy Nation CDC will implement Active People, Healthy Nation [2] to create more places for people of all ages and abilities to be physically active including: Complete Streets; community plans for parks and recreation; safe routes to schools; safer, more accessible places for walking and biking; and evidence-based physical activity interventions to prevent and control disease. Access to Healthy Foods CDC will support maternity care practices and worksite supports for breastfeeding; implementation of food service guidelines in worksites and in community settings; and integration of nutrition standards into statewide early care and education (ECE) systems.

2 State Physical Activity and Nutrition Program CDC will fund the State Physical Activity and Nutrition Program (SPAN) which provides substantive levels of funding to implement evidence-based strategies at state and local levels to improve nutrition and physical activity. It is estimated for each additional $1.2 million in SPAN funding, an additional state could be added to the program. High Obesity Program CDC will fund the High Obesity program which enables land grant universities to work with community extension services to increase access to healthier foods and safe and accessible places for physical activity in counties that have more than 40% of adults with obesity. We greatly appreciate your consideration of our request to provide $110 million in FY2020 to the CDC s Division of Nutrition, Physical Activity and Obesity with an additional $15million specifically for continued funding of the High Obesity Program. This investment is critical to help public health officials and organizations support healthy eating and active living in states and communities across the nation. Implementing these initiatives and programs will help prevent obesity, reduce the risk of chronic diseases and lower healthcare costs. We greatly appreciate your consideration of this request and would be happy to discuss it further with you. Sincerely, America Walks American Association on Health and Disability American College of Sports Medicine American Council on Exercise American Heart Association American Institute for Cancer Research American Physical Therapy Association Association of State Public Health Nutritionists BikeWalkKC Center for Science in the Public Interest Childhood Obesity Prevention Coalition City University of New York School of Medicine College of Public Health, University of South Florida Disabled Sports USA FlagHouse, Inc.

3 Focused Fitness Focused on Community Health Freeman Health Resources in Action Healthy Bodies Healthy Minds Healthy Weight Partnership - MEND International Council on Active Aging Iowa State University Kaiser Permanente Georgia Lakeshore Foundation League of American Bicyclists Milken Institute School of Public Health, George Washington University My Healthy Neighborhood MYZONE National Association for Health and Fitness National Association of Chronic Disease Directors National Association of Pediatric Nurse Practitioners National Athletic Trainers' Association National Coalition for Promoting Physical Activity National Complete Streets Coalition National Council of Youth Sports National Hockey League National Physical Activity Society National Recreation and Park Association NIRSA: Leaders in Collegiate Recreation ON THE MOVE Partnership to Fight Chronic Disease Pop Warner Little Scholars, Inc. Preventive Cardiovascular Nurses Association Rails-to-Trails Conservancy

4 rawfoodmealplanner.com Redstone Global Center for Prevention and Wellness Road Runners Club of America Safe Routes to School National Partnership SHAPE America Society for Public Health Education Solera Health Sports & Fitness Industry Association Suquamish Tribe The Anxiety & Depression Initiative, Inc. The Cooper Institute The Los Angeles Trust for Children's Health Triathlon Family USA, Inc. Trust for America's Health United States Breastfeeding Committee Walden University Walk with a Doc Washington State Department of Health West Valley Neighborhoods Coalition Women Advancing Nutrition Dietetics and Agriculture YMCA of the USA Zero Breast Cancer i [1] Inadequate levels of physical activity are associated with about $117 billion in annual healthcare costs. The estimated annual medical cost of obesity in the U.S. was $149 billion in 2016, half of those expenses paid by publicly financed Medicare and Medicaid programs. Low rates of breastfeeding add $3 billion a year to health care costs. [2] Active People, Healthy Nation is a comprehensive national initiative led by CDC to help 27 million Americans become more physically active by ii Obesity Prevention Source. Economic Costs: Paying the Price for Those Extra Pounds. Harvard T.H. Chan School of Public Health. (accessed April 11, 2018). iii Kim DD, Basu A. Estimating the medical care costs of obesity in the United States: Systematic review, meta-analysis, and empirical analysis. Value Health, 19(5): , doi: /j.jval iv Finkelstein EA, Trogdon JG, Cohen JW, et al. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Affairs, 28(5): w822-31, doi: /hlthaff w822.

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